Individual
DR. BAHRAM DIDEBAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
18741 HIGH SPRINGS MAIN ST, HIGH SPRINGS, FL 32643-0074
(786) 300-7808
Mailing address
1625 NW 19TH CIR, GAINESVILLE, FL 32605-4093
(786) 300-7808
(786) 565-4941
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME136670
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100007200
—
FL
Enumeration date
07/18/2015
Last updated
06/20/2023
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